1246 Partial Phalloplasty After Oncologic Resection: A Challenge for Health Centers in Remote Area of Indonesia

Abstract

Background Restoring penile function for urination and sexual activity, and achieving cosmetic result, are the goals of penile reconstruction including in post-malignancy reconstruction. Lack of studies has reported the usage of radial forearm flap on partial phalloplasty. Case Presentation A 31-years old male presented with fragile, cauliflower-like mass sizing 6x8 cm. The tumor had covered whole glans until the middle shaft of the penis. Plan of treatment for this patient started with complete excision of the tumor (partial penectomy), continued with phalloplasty. Phalloplasty consisted of using radial forearm flap (RFF) for penile foreskin (including glans), reconstructing corporal bodies using sartorius muscle, reshaping the penile glans, and urethroplasty to correct the hypospadic-looking urethra. Radial forearm flap of the non-dominant arm was implanted on the remaining foreskin of the penis, continued with wound care. On the 7th day postoperatively, no signs of necrotic, wound dehiscence, nor pus were observed, with capillary refill time on the distal fingers shown less than 2 seconds. Further evaluation is scheduled. Conclusions Loss of physiologic function usually follows partial penilectomy, which could lead to decrease in psychological quality of life. The main goal of the reconstruction of penile foreskin (including glans) using RFF is to form a newly formed penile glans that would have a cosmetic appearance nearly similar to a normal glans, which could improve its physiologic function and benefit psychologically. A challenge for health care centers in remote is is how to monitor and maintain a viable flap after the reconstruction and to keep a regular evaluation from the patient.